(NHS, 2014: 2). It recognises that The 5YFV proposes a set of The intention to integrate services local authorities are increasingly priorities to enhance prevention. is not just a policy objective shared working together to drive health and One such priority focuses on by the Care Act and 5YFV; it is wellbeing, and that the NHS can play “local democratic leadership on being put into practice around the its part in this through local Health public health” (NHS, 2014: 10). country. Greater Manchester is one 11 and Wellbeing Boards (HWBs). Specifically, by participating in local such example (or ‘vanguard site’ to HWBs, the NHS will play a part in use the NHS term) where the triple initiatives contingent on integrated integration ambition could become “as we think about the services and the realisation of a reality through a radical new changing needs and local-level priorities that necessarily model of a single integrated health preferences of the people incorporate considerations around and social care budget. Ten local we are here to serve, we wellbeing. This integrative approach authorities, the 12 CCGs for Greater is reflected in the Care Act 2014, Manchester and NHS England need to have integration which states that a local authority are working together to “devolve between primary and “must co-operate with each of its responsibility for the health and specialist services, we need relevant partners, and each relevant social care budget to a new Greater to have integration between partner must co-operate with the Manchester partnership” (LGA, physical and mental health authority, in exercise of…their 2015). This partnership will oversee services, and we need respective function relating to adults a £6 million budget from April 2016, with needs for care and support” which will be used to improve to have more integration (Care Act, 2014: 6). services, and health and wellbeing between health and social Integration outcomes. care services; that is the The Care Act’s ‘new models’ Prevention triple integration agenda include approaches towards The Care Act 2014 places a new that we are pursuing” (The greater integration of services. As duty of prevention onto local King’s Fund, 2015). the guidance explains, “the vision authorities: is for integrated care and support 1. “A local authority must provide [to be] person-centred, tailored to or arrange for the provision of HWBs were established through the needs and preferences of those services, facilities or resources, the Health and Social Care Act, needing care and support, carers or take steps, which it considers 2012. They are intended to act as a and families” (DH, 2014a: 281). will – forum where leaders from the health Integration encompasses health and care sector work together to and health-related services, as (a) contribute towards improve the health and wellbeing of well as achieving parity of esteem preventing or delaying the their local population and to reduce for mental and physical health, development by adults in its health inequalities. and integrating the corresponding area of needs for care and services in order to treat, care support; According to the 2012 Act, a HWB for and support the ‘whole (b) contribute towards must “for the purpose of advancing person’. Integration is recognised preventing or delaying the the health and wellbeing of the within the statutory guidance to development by carers in its people in its area, encourage… be dependent upon enhanced area of needs for support; the provision of any health or social cooperation between local care services…in an integrated authorities and partners, including (c) reduce the needs for care manner” (201). Through HWBs, local the NHS and CCGs. and support of adults in its authorities and CCGs undertake area; Joint Strategic Needs Assessments Simon Stevens, Chief Executive (d) reduce the needs for support 12 (JSNAs) and develop a Joint of NHS England, has extolled of carers in its area.” Health and Wellbeing Strategy to the “triple integration agenda” of best address these needs. This the 5YFV: “as we think about the The Red Cross advocated strongly includes making recommendations changing needs and preferences of for prevention to be not only included for joint commissioning and the people we are here to serve, we in the Care Act, but also defined. We integration of services across health need to have integration between were successful, with three equally and care. primary and specialist services, important forms of prevention being we need to have integration written into the statutory guidance. between physical and mental health The 5YFV does not share the Care 11 Providing a framework for reciprocity, Sections services, and we need to have 14Z11 and 14Z13 of the Health and Social Care Act’s recognition that prevention is Act 2012 indicate how HWBs participate in the more integration between health a continuum: across the life course; development of CCGs’ annual plans. and social care services; that is the 12 JSNA is a process that assesses and maps across the pathology of a long- the needs and demand for health and care triple integration agenda that we are term condition; and across physical and support. This information should feed into pursuing” (The King’s Fund, 2015). the board’s development of joint Health and health, mental health and emotional Wellbeing Strategies. 6